Incidence and long-term outcomes of pregnant women complicated with pulmonary arterial hypertension during different pregnancies: A prospective cohort study from China
Incidence and long-term outcomes of pregnant women complicated with pulmonary arterial hypertension during different pregnancies: A prospective cohort study from China
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DOI：
10.1016/j.ijcard.2020.10.021
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发表时间：
2021-02-08
影响因子：
3.5
通讯作者：
Lin, Jianhua
中科院分区：
文献类型：
--
作者：
Yang, Menghui;Wang, Jian;Lin, Jianhua
背景：妊娠期肺动脉高压（PAH）是母婴死亡的危险因素。本研究旨在探讨不同妊娠期孕妇合并多环芳烃的特点及结局。方法：对2012 - 2018年首次和第二次妊娠合并PAH的妇女的临床资料进行比较。结果：共纳入156例妊娠期新诊断的PAH患者。其中108例（26.9 +/- 3.5岁）和48例（30.8 +/- 4.8岁）在首次妊娠和第二次妊娠时诊断为PAH。发病率分别为5.7‰和6.6‰（p = 0.448）。第二次妊娠组肺动脉收缩压（sPAP）（55 +/- 19比71 +/- 27 mmHg， p = 0.001）、NYHA功能等级III-IV级患者（10.2%比35.4%,p < 0.001）和心力衰竭发生率（5.6%比18.8%,p = 0.01）高于第一次妊娠组。多因素线性回归显示胎次和出现症状时间是妊娠期sPAP的独立影响因素（p < 0.001）。多因素logistic回归分析显示sPAP （OR = 1.045, 95% CI, 1.021-1.069）是围产期心力衰竭的危险因素，临界值为56 mmHg（约登指数0.586，敏感性93%，特异性65%）。第一次和第二次妊娠组48个月的累计死亡率（IQR: 29 ~ 71）分别为2.8%和10.4% （p = 0.033）。结论：妊娠期多环芳烃的发病率随着胎次的增加而增加。在第二次怀孕期间发现的多环芳烃与更严重的疾病和较差的长期预后有关。(C) 2020 Elsevier B.V.版权所有
Background: Pulmonary arterial hypertension(PAH) in pregnancy is a risk factor for maternal and infant death. Our study was to explore the characteristics and outcomes of pregnant women complicated with PAH during different pregnancies.Method: Clinical data were compared among women complicated with PAH in the first and second pregnancy between 2012 and 2018.Results: A total of 156 patients with newly diagnosed PAH during pregnancy were enrolled. Among them, 108 (26.9 +/- 3.5 years old) and 48 (30.8 +/- 4.8 years old) were diagnosed PAH during their first and second pregnancy, respectively. And the incidence rates were 5.7 parts per thousand and 6.6 parts per thousand (p = 0.448). Pulmonary artery systolic pressure( sPAP) (55 +/- 19 vs. 71 +/- 27 mmHg, p = 0.001), NYHA functional class III-IV patients (10.2% vs. 35.4%, p < 0.001) and incidence of heart failure (5.6% vs. 18.8%, p = 0.01) were higher in the second pregnancy group than those in the first pregnancy group. Multivariate linear regression revealed that parity and time of symptom onset were independent factors of sPAP during pregnancy (p < 0.001). Multivariate logistic regression revealed that sPAP (OR = 1.045, 95% CI, 1.021-1.069) was a risk factor for perinatal heart failure, with a cut-off value of 56 mmHg (Youden index 0.586, sensitivity 93%, specificity 65%). The cumulative death rate in the subsequent 48 months (IQR: 29 to 71) were 2.8% and 10.4% (p = 0.033) in the first and second pregnancy group, respectively.Conclusions: Incidence of PAH in pregnancy tends to increase with increased parity. PAH identified in during the second pregnancy were associated with more severe disease and poorer long term outcomes. (C) 2020 Elsevier B.V. All rights reserved.